COVID-19 vaccine acceptance and hesitancy among primary healthcare workers in Singapore

Background Factors affecting COVID-19 vaccine acceptance and hesitancy among primary healthcare workers (HCW) remain poorly understood. This study aims to identify factors associated with vaccine acceptance and hesitancy among HCW. Methods A multi-centre online cross-sectional survey was performed across 6 primary care clinics from May to June 2021, after completion of staff vaccination exercise. Demographics, profession, years working in healthcare, residential status, presence of chronic medical conditions, self-perceived risk of acquiring COVID-19 and previous influenza vaccination were collected. HCW who accepted vaccine were then asked to rank their top 5 reasons for vaccine acceptance; HCW who were vaccine hesitant had to complete the 15-item 5C scale on psychological antecedents of vaccination. Results Five hundred fifty seven out of 1182 eligible HCW responded (47.1%). Twenty nine were excluded due to contraindications. Among 528 respondents, vaccine acceptance rate was 94.9% (n = 501). There were no statistically significant differences in COVID-19 vaccine acceptance between sex, age, ethnicity, profession, number of years in healthcare, living alone, presence of chronic diseases, self-perceived risk or previous influenza vaccination. The top 3 reasons for COVID-19 vaccine acceptance ranked by 501 HCW were to protect their family and friends, protect themselves from COVID-19 and due to high risk of acquiring COVID-19 because of their jobs. HCW with suspected or confirmed COVID-19 exposure were 3.4 times more likely to rank ‘high risk at work’ as one of the top reasons for vaccine acceptance (χ2 = 41.9, p < 0.001, OR = 3.38, 95%C.I. 2.32–4.93). High mean scores of ‘Calculation’ (5.79) and low scores for ‘Constraint’ (2.85) for 5C components among vaccine hesitant HCW (n = 27) highlighted that accessibility was not a concern; HCW took time to weigh vaccine benefits and consequences. Conclusion COVID-19 vaccine hesitancy is a minute issue among Singapore primary HCW, having achieved close to 95% acceptance rate. COVID-19 exposure risk influences vaccine acceptance; time is required for HCW to weigh benefits against the risks. Future studies can focus on settings with higher hesitancy rates, and acceptance of booster vaccinations with the emergence of delta and omicron variants. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01693-z.

If you agree to participate in this study, you will be asked to answer a questionnaire. The questionnaire will take about 10 to 15 minutes of your time.
The questionnaire is self-administered. This is a dual time-point study and the questionnaire will be administered today. Subjected to the study team's decision and research outcome, the questionnaire may be repeated in 6 to 12 months to re-assess your perceptions and attitudes towards the COVID-19 vaccine.
The questionnaire consists of questions which will explore reasons for taking the vaccination, contraindications to vaccination, self-perceived risk of acquiring COVID-19 and questions based on the 5C scale on the 5 psychological antecedents of vaccination.

Your Responsibilities in This Study
If you agree to participate in this study, you may proceed to start lling up the questionnaire.

What Is Not Standard Care or is Experimental in This Study
The study is being conducted because we want to understand more about your knowledge and perception of COVID-19 vaccination. The study involves answering a questionnaire. It does not affect the treatment and care which you will be receiving.

Possible Risks and Side Effects
This is an observational cross-sectional study involving the administering of a questionnaire. As this study involves the administration of a single questionnaire, physical harm is extremely unlikely. You may feel uncomfortable answering some questions. You may contact the Principal Investigator and be referred to a counsellor or Medical Social Worker should the need arise.
Con dentiality of vaccination preferences will be maintained as lling up form via FormSG ensures strict anonymity.

Possible Bene ts from Participating in the Study
There is no direct bene t from participation in this study. However, your participation in this study will add to the knowledge of vaccine hesitancy with regards to the COVID-19 vaccine. Your responses would help policy makers to formulate suitable programmes and measures to encourage COVID-19 vaccine uptake amongst Singaporeans, and other healthcare workers.

Alternatives to Participation
If you choose not to take part in this study, you will not be discriminated against or identi ed.

Costs & Payments if Participating in the Study
There are no charges involved when you agree to participate in the study.

Voluntary Participation
Your participation in this study is voluntary. You may stop participating in this study at any time. Your decision to not take part in this study or to stop your participation will not affect any bene ts to which you are entitled. If you decide to stop taking part in this study, you should tell the Principal Investigator or not submit the questionnaire.
However, the data that have been collected until the time of your withdrawal will be kept and analyzed. The reason is to enable a complete and comprehensive evaluation of the study.
In the event of any new information becoming available that may be relevant to your willingness to continue in this study, you (or your legally acceptable representative, if relevant) will be informed in a timely manner by the Principal Investigator or his/her representative.

Con dentiality of Study and Medical Records
Your participation in this study will not involve the collection of "Personal Data".
"Personal Data" means data about you which makes you identi able (i) from such data or (ii) from that data and other information which an organisation has or likely to have access. This includes medical conditions, medications, investigations and treatment history.
Information collected for this study will be kept con dential. Your records, to the extent of the applicable laws and regulations, will not be made publicly available.
However, National University Polyclinics, Domain Speci c Review Board and Ministry of Health will be granted direct access to your information to check study procedures and data, without making any of your information public.
You will not be asked for any identi able details such as NRIC, Name or Date of Birth. In order to protect your identity and the con dentiality of your information, data will be collected, stored and encrypted by form.gov.sg. Data collected and entered into the organization electronic system are the property of National University Health System. Access to this information will be strictly controlled with the aid of a security code system, restricted to members of the study team. In the event of any publication regarding this study, your identity will remain con dential. I am currently breastfeeding or planning for pregnancy; it is best to avoid COVID-19 vaccine for now